title: Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications.
abstract: OBJECTIVE
  Severity of obstructive sleep apnea (OSA) has been associated with poorer glycemic control in type 2 diabetes. It is not known whether obstructive events during rapid eye movement (REM) sleep have a different metabolic impact compared with those during non-REM (NREM) sleep. Treatment of OSA is often limited to the first half of the night, when NREM rather than REM sleep predominates. We aimed to quantify the impact of OSA in REM versus NREM sleep on hemoglobin A1c (HbA1c) in subjects with type 2 diabetes.
  
  
  METHODS
  All participants underwent polysomnography, and glycemic control was assessed by HbA1c.
  
  
  RESULTS
  Our analytic cohort included 115 subjects (65 women; age 55.2 ± 9.8 years; BMI 34.5 ± 7.5 kg/m(2)). In a multivariate linear regression model, REM apnea-hypopnea index (AHI) was independently associated with increasing levels of HbA1c (P = 0.008). In contrast, NREM AHI was not associated with HbA1c (P = 0.762). The mean adjusted HbA1c increased from 6.3% in subjects in the lowest quartile of REM AHI to 7.3% in subjects in the highest quartile of REM AHI (P = 0.044 for linear trend). Our model predicts that 4 h of continuous positive airway pressure (CPAP) use would leave 60% of REM sleep untreated and would be associated with a decrease in HbA1c by approximately 0.25%. In contrast, 7 h of CPAP use would cover more than 85% of REM sleep and would be associated with a decrease in HbA1c by as much as 1%.
  
  
  CONCLUSIONS
  In type 2 diabetes, OSA during REM sleep may influence long-term glycemic control. The metabolic benefits of CPAP therapy may not be achieved with the typical adherence of 4 h per night.
authors.affiliation: Corresponding author: Babak Mokhlesi, bmokhles@medicine.bsd.uchicago.edu.
authors.forename: Daniela
authors.initials: D
authors.lastname: Grimaldi
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Beccuti
authors.forename: Carol
authors.initials: C
authors.lastname: Touma
authors.forename: Eve
authors.initials: E
authors.lastname: Van Cauter
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology; D012895:Sleep, REM
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin